Guideline for coding organ donation after death

This page explains how we code organ donation after death; it has it's own page because many concepts tie together around this and the information should only live in one place. See also Guideline for coding living donor organ donation.

ExpandBackground

We usually encode death in Dispo; for patients with dx Brain death who are moved to a different location for Organ donor (organ/tissue donation by the donor) this means we lose either the info about their death or their new location. We needed a special case compromise to ensure this is dealt with consistently.

Transition to new organ donor dispo field use

• We are going to keep the old entries (died - donor and died - not a donor) available, and you don't need to change them for patients you have already entered
  • Main office will run a query to change all the old entries to the new version. We need to do this anyway and it is quicker than collectors doing it manually, so don't waste the time to change these to the new format
• For all new patients, please use the new fields (will be rolled later on today. Ttenbergen 09:00, 2019 June 4 (CDT))

Instructions for coding these patients

• Dispo DtTm: sent from ICU to the operating room or to another ICU (consistent with other Operating room visits
  • ie not the time of death

Discharge to OR (same or other site)

• Acquired Diagnosis: Brain death
  • Dx Date: Date brain death declared
• Dispo: Death - to OR

Discharge to another site ICU for harvesting

Sending site

• Acquired Diagnosis: Brain death
  • Dx Date: Date brain death declared
• Dispo: Death - to other ICU

Receiving site

• Acquired Diagnosis: Organ donor (organ/tissue donation by the donor)
  • Dx Date: use the Dispo Dt of the receiving site
• Admit Diagnosis: Brain death
• Previous Location: the previous ICU
• Dispo: Hopefully "Death - to OR", or "Death - to morgue" if transplant doesn't work out

Donation after Cardiac Death (DCD)

Donation after cardiac death (DCD) is where a donor who is not brain dead is dependent on life support and the family has decided to withdraw care. When the patient's heart stops beating, the organs are then recovered in the operating room.

These would be coded with Dispo as the OR where they are going. They are not dead when they leave, so they are not "Death - to OR".

2 Organ Donation I had one patient where they withdrew care in the unit then went directly to the OR to harvest the organs. What do we do in this case?--LKolesar 08:03, 2019 June 5 (CDT) AG REPLY -- then DO code the death in the ICU with the time being the actual time of death and the dispo as Death - to OR

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MAID

Medical Assistance in Dying (MAID) is where a person who undergoes MAID has made arrangements in advance for organ harvesting after death.

2 Organ Donation What are the instructions for this? Would they go through the exercise of declaring such a patient's Brain death or would we capture them as Acquired Diagnosis MAID and Dispo "Death - to OR" or more problematically "Death - to other ICU" ? AG REPLY: if a MAID patient who dies in ICU becomes a (planned) donor, then the dispo is Death - to OR, i.e. no need to bring up brain death. If MAID is provided in the OR, then handle this like DCD (see above) BUT also do list the ICD10 code for MAID as an acquired dx in ICU

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How they are treated in linking

• Populate linking pairs will not be affected since it only looks at PHINs and times

Cross checks that are affected

_dev_CFE The following in Correcting suspect links will need to be updated for this: Link suspect dead then alive query would it be right to say that these are allowed so long as the Admit Diagnosis is Brain death? How about other ? Link suspect mismatch to ours incomplete query would it be right to say that these are allowed so long as any diagnosis is Brain death? (not just acquired, since mayyyyybe the pt came from a third site and it's the admit...)

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How reports are affected

other fields/indicators/reports that might be affected

• Critical Care Inter-facility Transfer Report - won't be affected because it looks at survived patients only, not expired.
• Re-admission - not affected because it involves those survived who went to ward or home and came back to ICU or ward, not expired who went to OR or another ICU.
• Mortality and readmission report - The effect on mortality rate will be negligible if we include or exclude these cases, so it was decided to treat them as all other patients